Patient Satisfaction , Marginal Adaptation And Biocompatibility of Milled Biohpp Polyetheretherketone (PEEK) Single Anterior Crowns Veneered With Two Different Techniques.

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Research question For patients in a need for anterior crown, does the use of Milled BioHPP PEEK copings veneered with CAD/CAM composite resin offer better patient satisfaction, marginal adaptation and biocompatibility when compared Milled BioHPP PEEK copings veneered with manual layering? Statement of the problem PEEK exhibits a unique modulus of elasticity close to human bone/dentine so it acts as a shock absorber with stress reducing effect. Moreover from a biologic point of view, PEEK is highly compatible with surrounding tissues and it has very promising surface properties . The use of peek in anterior area is limited due to its opaque nature and grayish color, this drawback has been overcome by the use of composite layering material . PEEK restorations can be veneered with manual or CAD/CAM techniques. Information is lacking regarding the influence of the veneering technique on the patient satisfaction , precision of fit and biocompatibility of these restorations which will in turn influence their performance in patient's satisfaction. Rationale To achieve high esthetics when using PEEK it must be veneered by esthetic material 3 . It is available to be used manually or to be milled by CAD/CAM. The manual veneering of the PEEK coping with composite might affect the marginal integrity and the surrounding gingival tissues leading to decrease in the patient satisfaction, while the CAD/CAM veneering technique is proposed to have better patient satisfaction , marginal adaptation and an excellent biocompatible effect on the surrounding tissue. The importance of this trial lies in providing an alternative solution to the manual veneering technique, which will, in-turn, provide better restoration longevity results Aim of the study: The aim of this study is to evaluate the patient satisfaction ,marginal adaptation and biocompatibility of milled BioHPP PEEK copings veneered with CAD/CAM composite resin and compare them to milled BioHPP PEEK copings veneered with manual layering. Null hypothesis: There is no difference in the patient satisfaction, marginal adaptation and biocompatibility between milled BioHPP PEEK copings veneered with CAD/CAM composite resin and milled BioHPP PEEK copings veneered with manual layering. Primary objective: - The Primary outcome: : patient satisfaction of the two groups will be assessed by rating score 0 unaccepted , 1 good , 2 excellent - Secondary outcome: Marginal adaptation of the two groups will be assessed using the modified Ryge criteria. - Tertiary outcome: Biocompatibility (Bleeding). Signs of inflammation and bleeding of the two groups will be recorded after clinical examination and probing using periodontal probe Trial design: - Randomized clinical trial Eligibility criteria: Inclusion criteria: All subjects are required to be: 1-From 18-50 years old, be able to read and sign the informed consent document. 2- Have no active periodontal or pulpal diseases, have teeth with good restorations 3- Psychologically and physically able to withstand conventional dental procedures 4- Patients in a need for anterior crown. 5- Able to return for follow-up examinations and evaluation Exclusion criteria 1\. Patient less than 18 or more than 50 years 2. Patient with active resistant periodontal diseases 3. Patients with poor oral hygiene and uncooperative patients 4. Pregnant women 5. Patients in the growth stage with partially erupted teeth 6. Psychiatric problems or unrealistic expectations

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